Experiences in Robotic Colorectal Surgery: Comprehensive Insights from a Multi-center Analysis Using the Senhance Robotic System

Experiences in Robotic Colorectal Surgery: Comprehensive Insights from a Multi-center Analysis Using the Senhance Robotic System | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Experiences in Robotic Colorectal Surgery: Comprehensive Insights from a Multi-center Analysis Using the Senhance Robotic System Narimantas E Samalavicius, Rita Karpiciute, Vaida Nausediene, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4615466/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 24 Oct, 2024 Read the published version in Journal of Robotic Surgery → Version 1 posted 6 You are reading this latest preprint version Abstract Introduction: Robotic-assisted surgery has revolutionised minimally invasive approaches, particularly in colorectal surgery. While many single-center studies on colorectal surgeries exist in present literature, including experiences with Senhance® Robotic Systems, comprehensive multi-center studies are lacking. This study, conducted through the TransEnterix European Patient Registry ("TRUST"), aims to assess the safety and feasibility in this context. Methods: The present study explored procedural times, complications, robotic malfunction and limitations, adverse events and pain management outcomes for colorectal procedures, including sigmoid resection, right hemicolectomy and rectal surgery collected in two European centers. Results: Data from 355 colorectal surgeries showed that the median duration of surgery was 147.2 minutes (IQR: 124.3–183.0), the docking time was reported with a median of 3.4 minutes (IQR: 2.0–5.4) and the console time was found at a mean of 84.4 minutes (SD: 33.6). Despite minimal blood loss, pain scores, and robotic malfunction, 2,9% of the cases (10 instances) required conversions to either an open or laparoscopic approach. Further, most robotic limitations were attributed to limited motion (18.9%, 67 cases) and collisions (11.5%, 41 cases). Adverse events (24 cases, 6.8%) were effectively managed, with 23 instances judged completely unrelated to the robotic system. Conclusion: This study underscores the positive outcomes and safety profile of Senhance® Robotic Systems in colorectal surgery, contributing valuable insights for future research and clinical practice. Robotic Surgery Colorectal Surgery Senhance Robotic System Minimally Invasive Multi-center Analysis Introduction Robotic-assisted surgery is one of the fastest-growing minimally invasive approaches, drastically substantially transforming medicine, particularly surgical disciplines. Its initial groundbreaking applications in urology [ 1 ] have paved the way for cutting-edge advancements such as single port approaches [ 2 ] and even procedures in neurosurgery [ 3 ], showcasing its potential implications across various specialities. The continuous evolution of robotic-assisted surgery underscores its versatility and promises transformative impacts on diverse medical domains. Colorectal surgery has quickly embraced robotic technology, leading to abundant literature on detailed outcomes compared to other approaches, including laparoscopic and open approaches based on different robotic systems. As the Da Vinci System (Intuitive Surgical, Inc., Sunnyvale, CA, USA) was the first robotic system introduced to the market, most centers worldwide conduct surgeries and report results using this system. The robotic surgery industry constantly continues to develop, introducing various new systems to the market. The Senhance® Robotic System (Asensus Surgical US, Inc., Durham, NC, USA) is an example. The system was previously known as TELELAP ALF-X by TransEnterix and made its market debut in 2014. It is now FDA and Conformité Européenne (Englisch: European conformity, CE) mark approved. The Senhance® Robotic System offers several advantages that potentially surpass those of other surgical systems. First, and in contrast to the Da Vinci System, the system uses mostly reusable and sterilisable instruments, contributing to lower procedural costs and the potential of an eco-friendly image. Furthermore, various groundbreaking highlights emerge from the robotic console and equipment. On the one hand, haptic feedback enhances safety by allowing the perception, assessment, and analysis of forces between the instrument and the patient’s tissue. On the other hand, glasses with eye-tracking and 3D visualisation empower the surgeon to control the view intuitively. The ergonomics are worth mentioning, as the surgeon operating the Senhance® console benefits from an ergonomically optimised seat with an angled footrest. The independently positionable robotic arms are controlled through an open console, ensuring secure communication with the nurses and assistants and heightened safety for both the team and the patient. Lastly, trocar placements align with typical laparoscopic positions, facilitating efficient hybrid interventions or fast conversions. Given its outstanding features, various reports on experiences with the Senhance® Robotic System in colorectal surgery have been published. The first colorectal series was published in 2017 by Spinelli and colleagues [ 4 ], followed by other patient series [ 5 – 9 , 4 ]. A recent systematic review [ 10 ] with six studies exploring the Senhance® Robotic System meta-analysed various parameters (e.g., duration of surgery, docking times, conversions, postoperative morbidities). It concluded that an acceptable safety profile, reasonable docking times, low conversion rates, and affordable case costs for colorectal surgeries. Recently, the first series using augmented intelligence (AI) with this robotic system was published, marking the inaugural report in the literature concerning the application of AI in robotic surgery (Samalavicius NE, Dulskas (in press). First Clinical experience using augmented intelligence in robotic colorectal cancer surgery with Senhance robotic platform. Ann Coloproctol 2024;1:00–00). However, there is still a lack of multi-center experiences that exceed single-site reports. Certainly, a multi-center study can achieve more accurate findings through increased sample sizes, improved external validity and possibly reduce bias. Therefore, the present study aims to explore the safety and feasibility of colorectal surgeries with the Senhance® Robotic System at two European centers. Methods Patients For the present report, the data used represent excerpts from the “TRUST” (The TransEnterix European Patient Registry for Robotic-assisted Laparoscopic Procedures in Urology, Abdominal Surgery, Thoracic and Gynecologic Surgery), which represents an international study group. For robotic-assisted colorectal surgery, adult patients were included from two European study centers (Klaipeda University Hospital, Lithuania and Evangelisches Hospital, Wesel, Germany). Patients were screened for eligibility for laparoscopic surgery. They were included when the indication for colorectal surgery and no absolute contraindications for laparoscopic surgery (e.g., severe cardiopulmonary diseases) or exclusion criteria such as life-threatening diseases, limiting the participant’s life expectation to less than 12 months or inability to give consent applied. Indications for robotic colorectal surgery mirrored the indications for laparoscopic surgery. Procedure Robotic-assisted colorectal surgeries were categorised into sigmoid resection, right hemicolectomy and rectal surgery. All procedures were entirely performed with the help of the Senhance® Robotic System. Various papers on procedural details, including our own, are published [ 11 – 18 , 6 , 19 , 20 ]. In general, three robotic arms were utilized alongside five trocar placements, with a preference for the combination of 12mm and 5mm trocars. The surgical teams conducting surgeries varied across locations. In Wesel, three surgeons and fourteen assistants formed 34 distinct constellations. In Klaipeda, the surgical teams comprised three surgeons and seven assistants, leading to three unique surgical constellations. After completing the procedure, “docking time“ (in minutes), “console time”, and“duration of surgery” (in minutes) were documented in a database. "Docking time" is the period between initiating and concluding the robot's docking to the trocars, while “console time” represents the time the cockpit surgeon operates through the robotic system. At the same time, "duration of surgery" refers to the time from the initial skin incision to the completion of suturing. Perioperative complications and adverse events (AE) were documented in detail when they occurred. Intraoperative complications included AEs involving visceral or vascular injury, cardiopulmonary events, major blood loss (> 500 mL), or the need for blood transfusion. Postoperative complications included AEs that are related to the procedure, such as infections (e.g. wound infection), insufficient anastomosis, sepsis, ileus, bowel obstruction, and venous thromboembolic events and occurred within 30 days postoperative. The recorded data on AEs and complications in the registry followed the Clavien Dindo Classifications for each event (Dindo et al. 2004). Severe AEs were identified when readmission, repeated surgery, or death occurred. In the event of any complication, the association with the robotic procedure and the Senhance® Robotic System was determined, and an international safety committee reassessed the link to the robotic procedure and system. Additionally, conversions to standard laparoscopy or open surgery were protocolled in the database. Finally, blood loss during the procedure was recorded by estimation and patient medication usage (according to the World Health Organisation (WHO) analgesic ladder [ 21 ]) as well as pain scores (on a 0–10 visual pain scale) were collected on a 0–10 visual pain scale (at one day postoperative and discharge). Each patient provided written informed consent for the robotic procedure. Demographic data such as age, sex, BMI, relevant diseases and previous abdominal surgery were gathered before the procedure. Study Initiation started in October 2017, and the database registry ended in November 2023. Confidentiality and patients’ anonymity were ensured. The study received approval from the Ethics Committee of the Medical Association of Westphalia-Lippe and the University of Münster (Approval Number: 2017-463-f-S) and was subsequently confirmed by multiple local approvals. Statistical analysis We used “statistical software SAS® 9.4 (TS1M6) for Microsoft Windows” [ 22 ] for statistical analysis. No imputation or replacement of missing values was undertaken. Continuous data were expressed using either the median with interquartile ranges (IQR) or mean ± standard deviation (SD). Categorical variables were presented in terms of frequencies and percentages. Results Demographic data and procedure details Three hundred fifty-five robotic-assisted colorectal surgeries (sigmoid resection, right hemicolectomy and rectal surgery) were recorded at both our centers (Wesel: 192 cases, 54% and Klaipeda: 163 cases, 46%). Sigmoid resection emerged as the most often performed, with 169 cases (47.6%) reported. Data was provided from 123 patients (34.7%) for rectal surgery data, and right hemicolectomy was predated in 63 cases (17.7%). Table 1 displays a breakdown of the colorectal procedures. The average age of the overall cohort was 64.8 years (SD: 12 years), with 56.9% female and 43.1% male patients. The patients' BMI averaged 26.3 kg/m² (SD: 4.5 kg/m²). Most of the study population did not present a smoking history (82.0%). However, a fairly large population was diagnosed with relevant comorbidities (37.7%) and reported a history of previous abdominal surgery (30.4%). For a comprehensive overview of demographic data, see Table 2 . Table 1 Colorectal Procedures Center Sigmoid Resection Rectal Surgery Right Hemicolectomy Total Klaipeda 23 92 48 163 Wesel 146 31 15 192 Total 169 123 63 355 Table 2 Demographic Data and Medical History Wesel Klaipeda Total N 192 163 355 Age (years) mean ± SD 64.8 ± 11.7 64.8 ± 12.4 64.8 ± 12.0 Gender Male 75 (39.1%) 78 (47.9%) 153 (43.1%) Female 117 (60.9%) 85 (52.1%) 202 (56.9%) BMI (kg/m²) mean ± SD 27.6 ± 5.1 24.8 ± 3.1 26.3 ± 4.5 History of smoking No 165 (85.9%) 126 (77.3%) 291 (82.0%) Yes 27 (14.1%) 37 (22.7%) 64 (18.0%) Relevant comorbidity No 63 (32.8%) 158 (96.9%) 221 (62.2%) Yes 129 (67.2%) 5 (3.1%) 134 (37.7%) Type of relevant comorbidity (multiple entries) Diabetes 14 (7.3%) 1 (0.6%) 15 (4.2%) Hypertension 83 (43.2%) 3 (1.8%) 86 (24.2%) Cardiovascular Co-morbidity 20 (10.4%) 1 (0.6%) 21 (5.9%) COPD or Impaired Respiratory Function 18 (9.4%) - 18 (5.1%) Impaired Renal Function 15 (7.8%) - 15 (4.2%) Liver Disease 2 (1.0%) - 2 (0.5%) Stroke - 1 (0.6%) 1 (0.3%) Sleep Apnea 2 (1.0%) - 2 (0.5%) GERD 10 (5.2%) - 10 (2.8%) Depression 5 (2.6%) - 5 (1.4%) Osteoarthritis 2 (1.0%) - 2 (0.5%) Chronic pain 2 (1.0%) - 2 (0.5%) Others 41 (21.4%) 2 (1.2%) 43 (12.1%) Previous relevant abdominal surgery No 91 (47.4%) 156 (95.7%) 247 (69.6%) Yes 101 (52.6%) 7 (4.3%) 108 (30.4) Type of relevant abdominal surgery (multiple entries) Open surgery 29 (15.1%) 1 (0.6%) 30 (8.5%) Laparoscopic surgery 78 (40.6%) 6 (3.7%) 84 (23.7%) Procedure time and blood loss Based on 355 robotic-assisted colorectal surgeries performed with the Senhance® Robotic System at our two European centers, the duration of surgery was found at a median of 147.2 minutes (IQR: 124.3–183.0, see Table 3 ). The docking time was reported with a median of 3.4 minutes (IQR: 2.0–5.4). Results for console time were found at a mean of 83.4 minutes (SD: 33.6). By investigating both centers individually, we can notice a reduction in times [(duration of surgery: Klaipeda: 165 minutes (IQR: 140.0–200.0) vs. Wesel: 132 minutes (IQR: 111.0–168.5), docking time: Klaipeda: 4 minutes (IQR: 2.0–7.0) vs. Wesel: 3 minutes (IQR: 2.0–4.0), console time: Klaipeda: 77.7 minutes (SD: 34.3) vs. Wesel: 90.2 minutes (SD:32.7)] with an increased caseload (Klaipeda: 163 vs. Wesel: 192). Blood loss was minimal (e.g. 0 ml or not measurable) in 71.8% (255 cases). If more than 0 ml were reported, a median of 96 ml (IQR: 62.1–173.0) was measured. Table 3 Procedure times. All values are stated in minutes Wesel Klaipeda Total N 192 163 355 Duration of surgery median 132 165 147.2 P25%-P75% 111.0-168.5 140.0-200.0 124.3–183.0 Docking time median 3 4 3.4 P25%-P75% 2.0–4.0 2.0–7.0 2.0-5.4 Console time mean 77.7 90.2 83.4 SD 34.3 32.7 33.6 Conversions and Malfunctions All procedures were finished successfully, with no mortality related to the procedure or robotic system. Nevertheless, conversions were required in 2,9% of cases (10 instances), signalling a shift away from the utilisation of Senhance® Robotic Systems in favour of standard laparoscopic and open surgery. One case (0.3%) needed continuation via laparoscopic surgery. Eight cases (2.3%) required continuation via open surgery, with three initially planned conversions. Another case (0.3%) was first attempted with a laparoscopic approach and was then converted to open surgery (see Table 4 ). In most cases, the reasons for conversions were limitations due to difficult anatomy, e.g., multiple adhesions, unexpected localisation of cancer, T4 tumors requiring multi-visceral resections, or intraoperative bleeding. Of 355 robotic-assisted colorectal surgeries, robotic malfunctions were documented as a rarity in one case (0.3%). This incident was defined as “other malfunction” and thus was not related to the robotic system's console, monitor, or camera. Additionally, the recorded event was fixable and did not require stopping the procedure or switching to another approach. Further, most robotic limitations were attributed to limited motion (18.9%, 67 cases) and collisions (11.5%, 41 cases). Of note, only single entries were allowed for robotic malfunction count, while multiple entries were permitted for the malfunction type and limitations. Detailed results are presented in Table 4 . Table 4 Conversion and malfunctions Wesel Klaipeda Total N 192 163 355 Conversion None 185 (96.4%) 160 (98.2%) 345 (97.1%) Laparscopic 1 (0.5%) - 1 (0.3%) Open 5 (2.6%) 3 (1.8%) 8 (2.3%) Laparoscopic + Open 1 (0.5%) - 1 (0.3%) Robot malfunctions No 191 (99.5%) 163 (100%) 354 (99%) Yes 1 (0.5%) -- 1 (0.3%) Type of Robot malfunction (multiple entries) Other malfunction 1 (0.5%) - 1 ( 0.3%) Robotic limitations (multiple entries) Collision 2 (1.0%) 39 (23.9%) 41 (11.9%) Limited motion 5 (2.6%) 62 (38.0%) 67 (19.4%) Open: open surgery, laparoscopic: laparoscopic surgery Adverse events Twenty-four intra- and postoperative AEs (6.8%) were documented throughout the study at both our centers, with twelve events reports at each center. Only one complication happened during surgery (non-robot-associated intraoperative bladder incision), which demanded conversion to open with no other consequences. The AEs included most often complications such as haemorrhage, hernia, anastomotic leakage, postoperative ileus, urinary retention, and stenosis. A detailed overview of all events can be found in Supplementary Table 1 . In total, ten reports (2.8%) were categorised as serious adverse events (SAE). They included occurrences such as haemorrhage, haematoma, anastomotic leak, postoperative ileus, colon descendens perforation and necrosis of the colon. Seven cases (2%) of the overall recorded AEs were judged with mild severity, 12 cases (3.4%) were evaluated as moderate severity, and five cases (1.4%) were referred to as SAEs. Twenty-three cases (6.5%, 95.8% of all AEs) were unrelated to the robotic system. Only one report (0.3%) is judged as possibly related to the Senhance® Robotic System. In this case, the patient experienced incontinence following primary rectal resection, possibly due to injury to surrounding nerve structures. All AEs were unexpected and were effectively treated with appropriate interventions. All patients were discharged in good health. Pain Across both centers, WHO medication types 1 (349 cases, 98.3%) and 3 (307 cases, 86.5%) were the most frequently administered (Aabha A. Anekar et al.). The overall pain scores indicated a minimal pain level of 3.1 (± 1.7) on a 0–10 visual pain scale one day postoperative. By discharge, the pain score had successfully decreased to an average of 1.2 (± 1.1), representing a more than 50% reduction. Results per center can be found in Table 5 . Table 5 Pain perception Wesel Klaipeda Total N 192 163 355 One day postoperative mean ± SD 3.1 ± 2.2 3.1 ± 0.8 3.1 ± 1.7 At discharge mean ± SD 1.2 ± 1.5 1.1 ± 0.4 1.2 ± 1.1 Discussion An important aspect of robotic surgery is that it is inevitably done by and through a robot. This robot is thus prone to face malfunctions. However, we found minimal malfunctions with the Senhance® Robotic System. Only limited motion and potential collisions were likely to occur. Typically, surgical operating rooms (ORs) do not have a separate dedicated room for the robot. Instead, they share the OR with procedures using open or laparoscopic approaches. Accordingly, the OR might not be optimised for the robotic procedures. Nevertheless, the collision, usually involving the robotic arms, can be easily resolved by the assistant or nurse. While limited motion is often indicated as a warning on the screen and can typically be addressed by those familiar with the system, it's worth noting that approximately one-third of patients in the recorded demographic data had previous abdominal surgery. Previous abdominal surgery is an important factor likely to result in adhesions. Furthermore, the average BMI was 26.3 kg/m², categorised as overweight and the average age was 64.8 (SD: 12.0) [ 23 ]. Elevated chances of adhesion and being overweight are likely attributed to limited motion. In addition to the complexity of procedures and their higher likelihood of conversion, AEs and SAEs, it is important to acknowledge that factors such as being overweight, older aged and adhesions can significantly increase the occurrence of AEs and SAEs. A thorough examination revealed that the Wesel center included significantly more patients with documented previous surgeries (Wesel: 52.6% vs. Klaipeda: 4.3%). However, conversions (7 cases), as well as AEs and SAEs (24 cases), were relatively low at the Wesel center, suggesting that this factor is of limited significance when operating with the Senhance® Robotic System. This highlights an overall limitation of the present study: some departments, such as the Klaipeda center, are still rather selective in applying robotic surgery, likely opting for patients who are most suitable for these procedures. The comparison with laparoscopic surgery is particularly intriguing and warrants further exploration. In Farah et al.’s recent comprehensive research [ 24 ] on 53.209 patients, robotic-assisted colorectal surgery demonstrated significantly lower conversion rates (4.3% vs 9.2%, p-value < 0.001) but longer duration of surgery (225 minutes vs 177 minutes, p-value < 0.001) compared to laparoscopy. Our current findings in a large cohort show a duration of surgery with a median of 147.2 minutes and are, thus, even lower than laparoscopic surgery. An explanation for this could be that regardless of whether surgeons perform laparoscopic surgery using monopolar/bipolar instruments and clips, or advanced bipolar/ultrasonic instruments for tasks such as vessel sealing, the Senhance™ Robotic System allows the preferred surgical technique to be maintained. For instance, at the Wesel center, vessels are prepared robotically and sealed with an ultracision device, whereas, in Klaipeda, stapling is the standard practice. Despite these variations in technique, the result remains consistent and the duration of surgery is low. This flexibility highlights a significant advantage of the Senhance™ system: established operating methods can be continued without necessitating a change in technique. Ultimately, this emphasises the safety and feasibility of the robotic system. Our conversion rate was reported at 2.3% for transitioning to an open approach, significantly higher than 0.3% for switching to laparoscopic approaches and 0.3% for initially attempting laparoscopic and open procedures. In consequence, the majority of procedures (97.1%) were performed robotically and rarely resorted to a shift to open or laparoscopic surgery. In this context, we can further highlight that simpler standard procedures are typically initiated at the beginning of robotic surgery integration. In contrast, more complex procedures are approached with greater experience, as exemplified especially at the Wesel center. At this center, three conversions to open surgery were initially planned due to the complex case or patient characteristics. Furthermore, the team constellations differed notably in Wesel and were drastically higher. This indicates that, despite not always having an expert team, robotic surgery integrates effectively and seamlessly even into smaller peripheral hospitals, resulting in positive outcomes and hardly any conversions. Overall, our results show that surgery was rarely converted or negatively influenced by the Senhance® Robotic System. Another feature of the Senhance® Robotic System is the ergonomic seating position. No standing or banding is involved in robotic surgery for the cockpit surgeon controlling the robotic console. This could reduce fatigue and enhance focus, especially compared to laparoscopic surgery. Our observed operating time of 147.2 minutes could reflect this. Based on the documented duration of surgery and docking time, we observe a decreasing trend as the number of cases increases across our two centers, indicating a reduction in times with increased experience. Even with constantly changing team constellations, Menke and colleagues previously identified and discussed this trend with the Senhance® Robotic System [ 25 ]. Exploring the highlights of the Senhance® Robotic System, the eye-tracking 3D visualisation is specific to the system, allowing surgeons to have a detailed, self-managed view of the surgical site. This enhanced visualisation helps in precise manoeuvring and better identification of anatomical structures. This becomes crucial when the surgical site might face an unclear situation and an AE. The Senhance® Robotic System further offers surgeons great agility and range of motion, as the robotic arms can mimic the movements of the surgeon's hands with increased precision. This is particularly advantageous in complex procedures involving delicate tissues. Lastly, the Senhance® Robotic System provides haptic feedback, allowing surgeons to feel a sense of touch during the procedure. This feature enhances the surgeon's ability to assess tissue characteristics and manipulate instruments more effectively. These factors collectively suggest that ambiguous situations are more effectively managed, and the surgeon maintains greater control throughout the procedure. Therefore, discussing AEs, especially intraoperative ones, is important in this context. Overall, 6.8% of the cases reported AEs. 95.8% were postoperative complications, while only one complication occurred during surgery (bladder rupture). This significantly emphasises the precise control maintained throughout the procedure. Important to emphasise is that the AEs were, in the majority of cases (23 cases, 6.5%, 95,6% of all AEs), unrelated to the robotic system and thus general AEs in the context of colorectal surgery but not for the Senhance® Robotic System. Only a minority (0.3%) were judged, possibly related to the system. These results are showing big improvement as initial findings with the Senhance® Robotic System by Spinelli and colleagues report a postoperative AEs rate of 35.5% [ 4 ]. The Da Vinci System (Intuitive Surgical, Inc., Sunnyvale, CA, USA) has also been investigated multiple times for adverse events. A study by Kim and colleagues reported an adverse event rate of 12% (6 cases) [ 26 ]. Meanwhile, a large-scale study by Huang and colleagues found a postoperative complication rate of 8.8% over five years [ 27 ]. Since we included both intraoperative and postoperative adverse events in our overall complication rate, the results are very favorable for demonstrating safey with the Senhance® Robotic System. Finally, Robotic-assisted surgery is a minimally invasive approach involving small incisions through which the robotic arms are inserted with surgical instruments and a camera. Typically, this method yields smaller scars, decreased blood loss, diminished pain, and faster recovery times when contrasted with open surgery [ 28 ]. This can be underlined by our results presenting minimal pain on the postoperative day one and a significant reduction of pain on the day of discharge. The reported pain was adequately managed with standard WHO pain medication and did not differ between our study centers. Regarding blood loss, respective recordings further support the minimal blood loss during robotic surgery. These aspects are, however, not specific to the Senhance® Robotic System but could also be found similarly in laparoscopic surgery [ 29 ]. Conclusion The study provides comprehensive insights into the outcomes and challenges of robotic-assisted colorectal surgeries with the Senhance® Robotic System across multiple centers. The detailed breakdown of our findings enhances our understanding of the nuances and variations in outcomes across different aspects of colorectal surgery. In conclusion, safety and feasibility are demonstrated with the Senhance® Robotic System, and its application across various surgeries in colorectal surgery is approved. Declarations Author Contribution All authors contributed to the study's conception and design. Material preparation, data collection and analysis were performed by N.E.S., R.K., V.N., F.W., O.M.H., V.M. . The first draft of the manuscript was written by N.E.S. and V.M. and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Acknowledgement Asensus Surgical US, Inc., Durham, NC, USA, and the TransEnterix European Patient Registry (TRUST) study group supported this study. Data Availability Data is available upon request. Competing Interests : The authors state that they have no conflicts of interest. References Horgan S, Vanuno D, Benedetti E (2002) Early experience with robotically assisted laparoscopic donor nephrectomy. Surg Laparosc Endosc Percutan Tech 12:64–70. https://doi.org/10.1097/00129689-200202000-00011 Chong JU, Lee JY, Lim JH (2023) Early experiences in robotic single-site plus one port platform for complex hepatobiliary and pancreatic surgery. Int J Med Robot:e2602. https://doi.org/10.1002/rcs.2602 Tan K, Peng Y, Li J et al. (2023) Long-term outcomes and cost-effectiveness evaluation of robot-assisted stereotactic hematoma drainage for spontaneous intracerebral hemorrhage. Front Neurol 14:1291634. https://doi.org/10.3389/fneur.2023.1291634 Spinelli A, David G, Gidaro S et al. (2017) First experience in colorectal surgery with a new robotic platform with haptic feedback. Colorectal Dis. https://doi.org/10.1111/codi.13882 Lin C-C, Huang S-C, Lin H-H et al. (2021) An early experience with the Senhance surgical robotic system in colorectal surgery: a single-institute study. Int J Med Robot 17:e2206. https://doi.org/10.1002/rcs.2206 Samalavicius NE, Dulskas A, Janusonis V et al. (2022) Robotic colorectal surgery using the Senhance® robotic system: a single center experience. Tech Coloproctol 26:437–442. https://doi.org/10.1007/s10151-022-02589-x Stephan D, Sälzer H, Willeke F (2018) First Experiences with the New Senhance® Telerobotic System in Visceral Surgery. Visc Med 34:31–36. https://doi.org/10.1159/000486111 Sasaki M, Hirano Y, Yonezawa H et al. (2022) Short-term results of robot-assisted colorectal cancer surgery using Senhance Digital Laparoscopy System. Asian J Endosc Surg 15:613–618. https://doi.org/10.1111/ases.13064 Darwich I, Stephan D, Klöckner-Lang M et al. (2020) A roadmap for robotic-assisted sigmoid resection in diverticular disease using a Senhance™ Surgical Robotic System: results and technical aspects. J Robot Surg 14:297–304. https://doi.org/10.1007/s11701-019-00980-9 McKechnie T, Khamar J, Daniel R et al. (2023) The Senhance Surgical System in Colorectal Surgery: A Systematic Review. J Robot Surg 17:325–334. https://doi.org/10.1007/s11701-022-01455-0 Samalavicius NE, Smolskas E, Deduchovas O et al. (2019) Robotic abdominoperineal resection for pT2N0M0 low rectal cancer using the Senhance TransEnterix robotic platform - a video vignette. Colorectal Dis 21:847–848. https://doi.org/10.1111/codi.14638 Samalavicius NE, Smolskas E, Deduchovas O et al. (2019) Robotic right colectomy using the new Senhance® robotic platform: a three-trocar technique - a video vignette. Colorectal Dis 21:1092–1093. https://doi.org/10.1111/codi.14712 Samalavicius NE, Smolskas E, Janusonis V et al. (2019) Robotic sigmoid resection for locally advanced cancer using the Senhance Transenterix robotic platform - a video vignette. Colorectal Dis 21:1216. https://doi.org/10.1111/codi.14768 Samalavicius NE, Janusonis V, Smolskas E et al. (2020) Transanal and robotic total mesorectal excision (robotic-assisted TaTME) using the Senhance® robotic system - a video vignette. Colorectal Dis 22:114–115. https://doi.org/10.1111/codi.14837 Samalavicius NE, Klimasauskiene V, Janusonis V et al. (2020) Robotic total mesorectal excision for mid-rectal cancer using the Senhance® robotic platform - a video vignette. Colorectal Dis 22:592–593. https://doi.org/10.1111/codi.14940 Kondo H, Yamaguchi S, Hirano Y et al. (2020) A first case of ileocecal resection using a Senhance Surgical System in Japan. Surg Case Rep 6:95. https://doi.org/10.1186/s40792-020-00859-0 Hirano Y, Kondo H, Miyawaki Y et al. (2021) Single-incision plus two-port robotic surgery for sigmoid colon cancer using the Senhance robotic system. Asian J Endosc Surg 14:94–96. https://doi.org/10.1111/ases.12822 Minagawa Y, Hirano Y, Kataoka A et al. (2021) The first single-incision plus one-port transverse colon resection using Senhance Digital Laparoscopy System: a case report. Surg Case Rep 7:89. https://doi.org/10.1186/s40792-021-01167-x Samalavicius NE, Klimasauskiene V, Janusonis V et al. (2022) Abdominoperineal resection for low rectal neuroendocrine carcinoma after neoadjuvant chemotherapy using the Senhance robotic system with articulating Radia instrument - A Video Vignette. Colorectal Dis 24:798–799. https://doi.org/10.1111/codi.16065 Samalavicius NE, Klimasauskiene V, Nausediene V et al. (2023) Sigmoid colon resection for sigmoid cancer using a Senhance robotic system and indocyanine green fluorescent angiography-a video correspondence. Colorectal Dis 25:1062–1063. https://doi.org/10.1111/codi.16453 Aabha A. Anekar, Joseph Maxwell Hendrix, Marco Cascella (2023) WHO Analgesic Ladder. In: Anekar AA, Hendrix JM, Cascella M (eds) StatPearls [Internet]. StatPearls Publishing SAS Institute Inc (2013) SAS/ACCESS®: Interface to ADABAS. SAS Institute Inc, Cary, NC Cdc (2022) All About Adult BMI. https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html . Accessed 25 Feb 2024 Farah E, Abreu AA, Rail B et al. (2023) Perioperative outcomes of robotic and laparoscopic surgery for colorectal cancer: a propensity score-matched analysis. World J Surg Oncol 21:272. https://doi.org/10.1186/s12957-023-03138-y Menke V, Kottmann T, Willeke F et al. (2023) Learning curves and procedural times in Senhance®-robotic assisted fundoplication: results from 237 consecutive patients undergoing robotic fundoplication in a single center as part of the European TRUST Robotic Surgery Registry Study. Surg Endosc 37:8254–8262. https://doi.org/10.1007/s00464-023-10226-3 Kim HS, Oh B-Y, Cheong C et al. (2023) Single-incision robotic colorectal surgery with the da Vinci SP® surgical system: initial results of 50 cases. Tech Coloproctol 27:589–599. https://doi.org/10.1007/s10151-023-02791-5 Huang Z-X, Zhou Z, Shi H-R et al. (2021) Postoperative complications after robotic resection of colorectal cancer: An analysis based on 5-year experience at a large-scale center. World J Gastrointest Surg 13:1660–1672. https://doi.org/10.4240/wjgs.v13.i12.1660 Reddy K, Gharde P, Tayade H et al. (2023) Advancements in Robotic Surgery: A Comprehensive Overview of Current Utilizations and Upcoming Frontiers. Cureus 15:e50415. https://doi.org/10.7759/cureus.50415 Agha R, Muir G (2003) Does laparoscopic surgery spell the end of the open surgeon? JRSM 96:544–546. https://doi.org/10.1258/jrsm.96.11.544 Samalavicius NE, Dulskas. First Clinical experience using augmented intelligence in robotic colorectal cancer surgery with Senhance robotic platform. Ann Coloproctol 2024;1:00–00 (accepted for publication, in press) – not yet ready to cite Supplementary table 1 Supplementary table 1 is not available with this version. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 24 Oct, 2024 Read the published version in Journal of Robotic Surgery → Version 1 posted Editorial decision: Accepted 05 Oct, 2024 Reviewers agreed at journal 15 Jul, 2024 Reviewers invited by journal 15 Jul, 2024 Editor assigned by journal 22 Jun, 2024 Submission checks completed at journal 22 Jun, 2024 First submitted to journal 21 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4615466","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":320807009,"identity":"53dbda9c-160c-4bdf-99f0-26a95947f2cf","order_by":0,"name":"Narimantas E Samalavicius","email":"data:image/png;base64,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","orcid":"","institution":"Klaipeda University Hospital","correspondingAuthor":true,"prefix":"","firstName":"Narimantas","middleName":"E","lastName":"Samalavicius","suffix":""},{"id":320807010,"identity":"1ca69e14-d0ee-44ea-b7a5-9a100ce34d8d","order_by":1,"name":"Rita Karpiciute","email":"","orcid":"","institution":"National Cancer Institute","correspondingAuthor":false,"prefix":"","firstName":"Rita","middleName":"","lastName":"Karpiciute","suffix":""},{"id":320807011,"identity":"53be5b3b-b501-45d4-8a7a-001cf24b8bcc","order_by":2,"name":"Vaida Nausediene","email":"","orcid":"","institution":"Klaipeda University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Vaida","middleName":"","lastName":"Nausediene","suffix":""},{"id":320807013,"identity":"00112e92-8432-4817-906e-58225b75761b","order_by":3,"name":"Frank Willeke","email":"","orcid":"","institution":"St.-Marien Hospital Siegen","correspondingAuthor":false,"prefix":"","firstName":"Frank","middleName":"","lastName":"Willeke","suffix":""},{"id":320807017,"identity":"1977c9ea-173d-481b-bb24-c8c7f7898209","order_by":4,"name":"Olaf Martin Hansen","email":"","orcid":"","institution":"Evangelisches Krankenhaus Wesel","correspondingAuthor":false,"prefix":"","firstName":"Olaf","middleName":"Martin","lastName":"Hansen","suffix":""},{"id":320807019,"identity":"e0118444-2086-4a41-840e-bb21af38fa22","order_by":5,"name":"Vivianda Menke","email":"","orcid":"","institution":"Evangelisches Krankenhaus Wesel","correspondingAuthor":false,"prefix":"","firstName":"Vivianda","middleName":"","lastName":"Menke","suffix":""}],"badges":[],"createdAt":"2024-06-21 07:01:00","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4615466/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4615466/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s11701-024-02136-w","type":"published","date":"2024-10-24T15:57:42+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":67681896,"identity":"c3218f5b-9e90-4d27-857a-e23e130cd052","added_by":"auto","created_at":"2024-10-28 16:11:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":579719,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4615466/v1/27d2fb05-b23d-43a0-bc45-e0eb9393da86.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Experiences in Robotic Colorectal Surgery: Comprehensive Insights from a Multi-center Analysis Using the Senhance Robotic System","fulltext":[{"header":"Introduction","content":"\u003cp\u003eRobotic-assisted surgery is one of the fastest-growing minimally invasive approaches, drastically substantially transforming medicine, particularly surgical disciplines. Its initial groundbreaking applications in urology [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] have paved the way for cutting-edge advancements such as single port approaches [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] and even procedures in neurosurgery [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], showcasing its potential implications across various specialities. The continuous evolution of robotic-assisted surgery underscores its versatility and promises transformative impacts on diverse medical domains. Colorectal surgery has quickly embraced robotic technology, leading to abundant literature on detailed outcomes compared to other approaches, including laparoscopic and open approaches based on different robotic systems. As the Da Vinci System (Intuitive Surgical, Inc., Sunnyvale, CA, USA) was the first robotic system introduced to the market, most centers worldwide conduct surgeries and report results using this system. The robotic surgery industry constantly continues to develop, introducing various new systems to the market. The Senhance® Robotic System (Asensus Surgical US, Inc., Durham, NC, USA) is an example. The system was previously known as TELELAP ALF-X by TransEnterix and made its market debut in 2014. It is now FDA and Conformité Européenne (Englisch: European conformity, CE) mark approved. The Senhance® Robotic System offers several advantages that potentially surpass those of other surgical systems. First, and in contrast to the Da Vinci System, the system uses mostly reusable and sterilisable instruments, contributing to lower procedural costs and the potential of an eco-friendly image. Furthermore, various groundbreaking highlights emerge from the robotic console and equipment. On the one hand, haptic feedback enhances safety by allowing the perception, assessment, and analysis of forces between the instrument and the patient’s tissue. On the other hand, glasses with eye-tracking and 3D visualisation empower the surgeon to control the view intuitively. The ergonomics are worth mentioning, as the surgeon operating the Senhance® console benefits from an ergonomically optimised seat with an angled footrest. The independently positionable robotic arms are controlled through an open console, ensuring secure communication with the nurses and assistants and heightened safety for both the team and the patient. Lastly, trocar placements align with typical laparoscopic positions, facilitating efficient hybrid interventions or fast conversions. Given its outstanding features, various reports on experiences with the Senhance® Robotic System in colorectal surgery have been published. The first colorectal series was published in 2017 by Spinelli and colleagues [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], followed by other patient series [\u003cspan additionalcitationids=\"CR6 CR7 CR8\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e–\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. A recent systematic review [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] with six studies exploring the Senhance® Robotic System meta-analysed various parameters (e.g., duration of surgery, docking times, conversions, postoperative morbidities). It concluded that an acceptable safety profile, reasonable docking times, low conversion rates, and affordable case costs for colorectal surgeries. Recently, the first series using augmented intelligence (AI) with this robotic system was published, marking the inaugural report in the literature concerning the application of AI in robotic surgery (Samalavicius NE, Dulskas (in press). First Clinical experience using augmented intelligence in robotic colorectal cancer surgery with Senhance robotic platform. Ann Coloproctol 2024;1:00–00).\u003c/p\u003e \u003cp\u003eHowever, there is still a lack of multi-center experiences that exceed single-site reports. Certainly, a multi-center study can achieve more accurate findings through increased sample sizes, improved external validity and possibly reduce bias. Therefore, the present study aims to explore the safety and feasibility of colorectal surgeries with the Senhance® Robotic System at two European centers.\u003c/p\u003e "},{"header":"Methods","content":"\u003cp\u003ePatients\u003c/p\u003e\u003cp\u003eFor the present report, the data used represent excerpts from the “TRUST” (The TransEnterix European Patient Registry for Robotic-assisted Laparoscopic Procedures in Urology, Abdominal Surgery, Thoracic and Gynecologic Surgery), which represents an international study group. For robotic-assisted colorectal surgery, adult patients were included from two European study centers (Klaipeda University Hospital, Lithuania and Evangelisches Hospital, Wesel, Germany). Patients were screened for eligibility for laparoscopic surgery. They were included when the indication for colorectal surgery and no absolute contraindications for laparoscopic surgery (e.g., severe cardiopulmonary diseases) or exclusion criteria such as life-threatening diseases, limiting the participant’s life expectation to less than 12 months or inability to give consent applied. Indications for robotic colorectal surgery mirrored the indications for laparoscopic surgery.\u003c/p\u003e\u003cp\u003eProcedure\u003c/p\u003e\u003cp\u003eRobotic-assisted colorectal surgeries were categorised into sigmoid resection, right hemicolectomy and rectal surgery. All procedures were entirely performed with the help of the Senhance® Robotic System. Various papers on procedural details, including our own, are published [\u003cspan additionalcitationids=\"CR12 CR13 CR14 CR15 CR16 CR17\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e–\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In general, three robotic arms were utilized alongside five trocar placements, with a preference for the combination of 12mm and 5mm trocars. The surgical teams conducting surgeries varied across locations. In Wesel, three surgeons and fourteen assistants formed 34 distinct constellations. In Klaipeda, the surgical teams comprised three surgeons and seven assistants, leading to three unique surgical constellations. After completing the procedure, “docking time“ (in minutes), “console time”, and“duration of surgery” (in minutes) were documented in a database. \"Docking time\" is the period between initiating and concluding the robot's docking to the trocars, while “console time” represents the time the cockpit surgeon operates through the robotic system. At the same time, \"duration of surgery\" refers to the time from the initial skin incision to the completion of suturing. Perioperative complications and adverse events (AE) were documented in detail when they occurred. Intraoperative complications included AEs involving visceral or vascular injury, cardiopulmonary events, major blood loss (\u0026gt; 500 mL), or the need for blood transfusion. Postoperative complications included AEs that are related to the procedure, such as infections (e.g. wound infection), insufficient anastomosis, sepsis, ileus, bowel obstruction, and venous thromboembolic events and occurred within 30 days postoperative. The recorded data on AEs and complications in the registry followed the Clavien Dindo Classifications for each event (Dindo et al. 2004). Severe AEs were identified when readmission, repeated surgery, or death occurred. In the event of any complication, the association with the robotic procedure and the Senhance® Robotic System was determined, and an international safety committee reassessed the link to the robotic procedure and system. Additionally, conversions to standard laparoscopy or open surgery were protocolled in the database. Finally, blood loss during the procedure was recorded by estimation and patient medication usage (according to the World Health Organisation (WHO) analgesic ladder [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]) as well as pain scores (on a 0–10 visual pain scale) were collected on a 0–10 visual pain scale (at one day postoperative and discharge).\u003c/p\u003e\u003cp\u003e Each patient provided written informed consent for the robotic procedure. Demographic data such as age, sex, BMI, relevant diseases and previous abdominal surgery were gathered before the procedure. Study Initiation started in October 2017, and the database registry ended in November 2023. Confidentiality and patients’ anonymity were ensured. The study received approval from the Ethics Committee of the Medical Association of Westphalia-Lippe and the University of Münster (Approval Number: 2017-463-f-S) and was subsequently confirmed by multiple local approvals.\u003c/p\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eWe used “statistical software SAS® 9.4 (TS1M6) for Microsoft Windows” [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] for statistical analysis. No imputation or replacement of missing values was undertaken. Continuous data were expressed using either the median with interquartile ranges (IQR) or mean ± standard deviation (SD). Categorical variables were presented in terms of frequencies and percentages.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eDemographic data and procedure details\u003c/p\u003e \u003cp\u003eThree hundred fifty-five robotic-assisted colorectal surgeries (sigmoid resection, right hemicolectomy and rectal surgery) were recorded at both our centers (Wesel: 192 cases, 54% and Klaipeda: 163 cases, 46%). Sigmoid resection emerged as the most often performed, with 169 cases (47.6%) reported. Data was provided from 123 patients (34.7%) for rectal surgery data, and right hemicolectomy was predated in 63 cases (17.7%). Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e displays a breakdown of the colorectal procedures.\u003c/p\u003e \u003cp\u003eThe average age of the overall cohort was 64.8 years (SD: 12 years), with 56.9% female and 43.1% male patients. The patients' BMI averaged 26.3 kg/m\u0026sup2; (SD: 4.5 kg/m\u0026sup2;). Most of the study population did not present a smoking history (82.0%). However, a fairly large population was diagnosed with relevant comorbidities (37.7%) and reported a history of previous abdominal surgery (30.4%). For a comprehensive overview of demographic data, see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eColorectal Procedures\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCenter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSigmoid Resection\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRectal Surgery\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRight Hemicolectomy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eTotal\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eKlaipeda\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e163\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWesel\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e192\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eTotal\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e355\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u0026nbsp;Demographic\u0026nbsp;Data\u0026nbsp;and\u0026nbsp;Medical\u0026nbsp;History\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWesel\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eKlaipeda\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e192\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e163\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e355\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64.8\u0026thinsp;\u0026plusmn;\u0026thinsp;11.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64.8\u0026thinsp;\u0026plusmn;\u0026thinsp;12.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e64.8\u0026thinsp;\u0026plusmn;\u0026thinsp;12.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75 (39.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e78 (47.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e153 (43.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e117 (60.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e85 (52.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e202 (56.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e (kg/m\u0026sup2;)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26.3\u0026thinsp;\u0026plusmn;\u0026thinsp;4.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eHistory of smoking\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e165 (85.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e126 (77.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e291 (82.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (14.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37 (22.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e64 (18.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eRelevant comorbidity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63 (32.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e158 (96.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e221 (62.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e129 (67.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (3.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e134 (37.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"12\" rowspan=\"13\"\u003e \u003cp\u003e\u003cb\u003eType of relevant comorbidity\u003c/b\u003e (multiple entries)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (7.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (0.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15 (4.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83 (43.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e86 (24.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCardiovascular Co-morbidity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (10.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (0.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21 (5.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCOPD or Impaired Respiratory Function\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (9.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18 (5.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImpaired Renal Function\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (7.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15 (4.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLiver Disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (1.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (0.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStroke\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (0.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (0.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSleep Apnea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (1.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (0.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGERD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (5.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 (2.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (2.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (1.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOsteoarthritis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (1.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (0.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChronic pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (1.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (0.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41 (21.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (1.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e43 (12.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003ePrevious relevant abdominal surgery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91 (47.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e156 (95.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e247 (69.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e101 (52.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (4.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e108 (30.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eType of relevant abdominal surgery\u003c/b\u003e (multiple entries)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOpen surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (15.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (0.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30 (8.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLaparoscopic surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78 (40.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (3.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e84 (23.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eProcedure time and blood loss\u003c/p\u003e \u003cp\u003eBased on 355 robotic-assisted colorectal surgeries performed with the Senhance\u0026reg; Robotic System at our two European centers, the duration of surgery was found at a median of 147.2 minutes (IQR: 124.3\u0026ndash;183.0, see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The docking time was reported with a median of 3.4 minutes (IQR: 2.0\u0026ndash;5.4). Results for console time were found at a mean of 83.4 minutes (SD: 33.6). By investigating both centers individually, we can notice a reduction in times [(duration of surgery: Klaipeda: 165 minutes (IQR: 140.0\u0026ndash;200.0) vs. Wesel: 132 minutes (IQR: 111.0\u0026ndash;168.5), docking time: Klaipeda: 4 minutes (IQR: 2.0\u0026ndash;7.0) vs. Wesel: 3 minutes (IQR: 2.0\u0026ndash;4.0), console time: Klaipeda: 77.7 minutes (SD: 34.3) vs. Wesel: 90.2 minutes (SD:32.7)] with an increased caseload (Klaipeda: 163 vs. Wesel: 192).\u003c/p\u003e \u003cp\u003eBlood loss was minimal (e.g. 0 ml or not measurable) in 71.8% (255 cases). If more than 0 ml were reported, a median of 96 ml (IQR: 62.1\u0026ndash;173.0) was measured.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eProcedure times. All values are stated in minutes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWesel\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eKlaipeda\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e192\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e163\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e355\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eDuration of surgery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emedian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e132\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e165\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e147.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP25%-P75%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e111.0-168.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e140.0-200.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e124.3\u0026ndash;183.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eDocking time\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emedian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eP25%-P75%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.0\u0026ndash;4.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.0\u0026ndash;7.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.0-5.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eConsole time\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e90.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e83.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eConversions and Malfunctions\u003c/p\u003e \u003cp\u003eAll procedures were finished successfully, with no mortality related to the procedure or robotic system. Nevertheless, conversions were required in 2,9% of cases (10 instances), signalling a shift away from the utilisation of Senhance\u0026reg; Robotic Systems in favour of standard laparoscopic and open surgery. One case (0.3%) needed continuation via laparoscopic surgery. Eight cases (2.3%) required continuation via open surgery, with three initially planned conversions. Another case (0.3%) was first attempted with a laparoscopic approach and was then converted to open surgery (see Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). In most cases, the reasons for conversions were limitations due to difficult anatomy, e.g., multiple adhesions, unexpected localisation of cancer, T4 tumors requiring multi-visceral resections, or intraoperative bleeding.\u003c/p\u003e \u003cp\u003eOf 355 robotic-assisted colorectal surgeries, robotic malfunctions were documented as a rarity in one case (0.3%). This incident was defined as \u0026ldquo;other malfunction\u0026rdquo; and thus was not related to the robotic system's console, monitor, or camera. Additionally, the recorded event was fixable and did not require stopping the procedure or switching to another approach. Further, most robotic limitations were attributed to limited motion (18.9%, 67 cases) and collisions (11.5%, 41 cases). Of note, only single entries were allowed for robotic malfunction count, while multiple entries were permitted for the malfunction type and limitations. Detailed results are presented in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eConversion\u0026nbsp;and\u0026nbsp;malfunctions\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWesel\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eKlaipeda\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e192\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e163\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e355\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eConversion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e185 (96.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e160 (98.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e345 (97.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLaparscopic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (0.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOpen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (2.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (2.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLaparoscopic\u0026thinsp;+\u0026thinsp;Open\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (0.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eRobot malfunctions\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e191 (99.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e163 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e354 (99%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (0.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of Robot malfunction\u003c/b\u003e (multiple entries)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther malfunction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 ( 0.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eRobotic limitations\u003c/b\u003e (multiple entries)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCollision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (1.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39 (23.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e41 (11.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLimited motion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (2.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62 (38.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e67 (19.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eOpen: open surgery, laparoscopic: laparoscopic surgery\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003ch2\u003eAdverse events\u003c/h2\u003e \u003cp\u003eTwenty-four intra- and postoperative AEs (6.8%) were documented throughout the study at both our centers, with twelve events reports at each center. Only one complication happened during surgery (non-robot-associated intraoperative bladder incision), which demanded conversion to open with no other consequences. The AEs included most often complications such as haemorrhage, hernia, anastomotic leakage, postoperative ileus, urinary retention, and stenosis. A detailed overview of all events can be found in \u003cb\u003eSupplementary Table\u0026nbsp;1\u003c/b\u003e. In total, ten reports (2.8%) were categorised as serious adverse events (SAE). They included occurrences such as haemorrhage, haematoma, anastomotic leak, postoperative ileus, colon descendens perforation and necrosis of the colon. Seven cases (2%) of the overall recorded AEs were judged with mild severity, 12 cases (3.4%) were evaluated as moderate severity, and five cases (1.4%) were referred to as SAEs. Twenty-three cases (6.5%, 95.8% of all AEs) were unrelated to the robotic system. Only one report (0.3%) is judged as possibly related to the Senhance\u0026reg; Robotic System. In this case, the patient experienced incontinence following primary rectal resection, possibly due to injury to surrounding nerve structures. All AEs were unexpected and were effectively treated with appropriate interventions. All patients were discharged in good health.\u003c/p\u003e \u003cp\u003ePain\u003c/p\u003e \u003cp\u003eAcross both centers, WHO medication types 1 (349 cases, 98.3%) and 3 (307 cases, 86.5%) were the most frequently administered (Aabha A. Anekar et al.). The overall pain scores indicated a minimal pain level of 3.1 (\u0026plusmn;\u0026thinsp;1.7) on a 0\u0026ndash;10 visual pain scale one day postoperative. By discharge, the pain score had successfully decreased to an average of 1.2 (\u0026plusmn;\u0026thinsp;1.1), representing a more than 50% reduction. Results per center can be found in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePain perception\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWesel\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eKlaipeda\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e192\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e163\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e355\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOne day postoperative\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAt discharge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAn important aspect of robotic surgery is that it is inevitably done by and through a robot. This robot is thus prone to face malfunctions. However, we found minimal malfunctions with the Senhance\u0026reg; Robotic System. Only limited motion and potential collisions were likely to occur. Typically, surgical operating rooms (ORs) do not have a separate dedicated room for the robot. Instead, they share the OR with procedures using open or laparoscopic approaches. Accordingly, the OR might not be optimised for the robotic procedures. Nevertheless, the collision, usually involving the robotic arms, can be easily resolved by the assistant or nurse. While limited motion is often indicated as a warning on the screen and can typically be addressed by those familiar with the system, it's worth noting that approximately one-third of patients in the recorded demographic data had previous abdominal surgery. Previous abdominal surgery is an important factor likely to result in adhesions. Furthermore, the average BMI was 26.3 kg/m\u0026sup2;, categorised as overweight and the average age was 64.8 (SD: 12.0) [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Elevated chances of adhesion and being overweight are likely attributed to limited motion. In addition to the complexity of procedures and their higher likelihood of conversion, AEs and SAEs, it is important to acknowledge that factors such as being overweight, older aged and adhesions can significantly increase the occurrence of AEs and SAEs. A thorough examination revealed that the Wesel center included significantly more patients with documented previous surgeries (Wesel: 52.6% vs. Klaipeda: 4.3%). However, conversions (7 cases), as well as AEs and SAEs (24 cases), were relatively low at the Wesel center, suggesting that this factor is of limited significance when operating with the Senhance\u0026reg; Robotic System. This highlights an overall limitation of the present study: some departments, such as the Klaipeda center, are still rather selective in applying robotic surgery, likely opting for patients who are most suitable for these procedures.\u003c/p\u003e \u003cp\u003eThe comparison with laparoscopic surgery is particularly intriguing and warrants further exploration. In Farah et al.\u0026rsquo;s recent comprehensive research [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] on 53.209 patients, robotic-assisted colorectal surgery demonstrated significantly lower conversion rates (4.3% vs 9.2%, p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001) but longer duration of surgery (225 minutes vs 177 minutes, p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001) compared to laparoscopy. Our current findings in a large cohort show a duration of surgery with a median of 147.2 minutes and are, thus, even lower than laparoscopic surgery. An explanation for this could be that regardless of whether surgeons perform laparoscopic surgery using monopolar/bipolar instruments and clips, or advanced bipolar/ultrasonic instruments for tasks such as vessel sealing, the Senhance\u0026trade; Robotic System allows the preferred surgical technique to be maintained. For instance, at the Wesel center, vessels are prepared robotically and sealed with an ultracision device, whereas, in Klaipeda, stapling is the standard practice. Despite these variations in technique, the result remains consistent and the duration of surgery is low. This flexibility highlights a significant advantage of the Senhance\u0026trade; system: established operating methods can be continued without necessitating a change in technique. Ultimately, this emphasises the safety and feasibility of the robotic system.\u003c/p\u003e \u003cp\u003eOur conversion rate was reported at 2.3% for transitioning to an open approach, significantly higher than 0.3% for switching to laparoscopic approaches and 0.3% for initially attempting laparoscopic and open procedures. In consequence, the majority of procedures (97.1%) were performed robotically and rarely resorted to a shift to open or laparoscopic surgery. In this context, we can further highlight that simpler standard procedures are typically initiated at the beginning of robotic surgery integration. In contrast, more complex procedures are approached with greater experience, as exemplified especially at the Wesel center. At this center, three conversions to open surgery were initially planned due to the complex case or patient characteristics. Furthermore, the team constellations differed notably in Wesel and were drastically higher. This indicates that, despite not always having an expert team, robotic surgery integrates effectively and seamlessly even into smaller peripheral hospitals, resulting in positive outcomes and hardly any conversions. Overall, our results show that surgery was rarely converted or negatively influenced by the Senhance\u0026reg; Robotic System.\u003c/p\u003e \u003cp\u003eAnother feature of the Senhance\u0026reg; Robotic System is the ergonomic seating position. No standing or banding is involved in robotic surgery for the cockpit surgeon controlling the robotic console. This could reduce fatigue and enhance focus, especially compared to laparoscopic surgery. Our observed operating time of 147.2 minutes could reflect this. Based on the documented duration of surgery and docking time, we observe a decreasing trend as the number of cases increases across our two centers, indicating a reduction in times with increased experience. Even with constantly changing team constellations, Menke and colleagues previously identified and discussed this trend with the Senhance\u0026reg; Robotic System [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eExploring the highlights of the Senhance\u0026reg; Robotic System, the eye-tracking 3D visualisation is specific to the system, allowing surgeons to have a detailed, self-managed view of the surgical site. This enhanced visualisation helps in precise manoeuvring and better identification of anatomical structures. This becomes crucial when the surgical site might face an unclear situation and an AE. The Senhance\u0026reg; Robotic System further offers surgeons great agility and range of motion, as the robotic arms can mimic the movements of the surgeon's hands with increased precision. This is particularly advantageous in complex procedures involving delicate tissues. Lastly, the Senhance\u0026reg; Robotic System provides haptic feedback, allowing surgeons to feel a sense of touch during the procedure. This feature enhances the surgeon's ability to assess tissue characteristics and manipulate instruments more effectively. These factors collectively suggest that ambiguous situations are more effectively managed, and the surgeon maintains greater control throughout the procedure. Therefore, discussing AEs, especially intraoperative ones, is important in this context. Overall, 6.8% of the cases reported AEs. 95.8% were postoperative complications, while only one complication occurred during surgery (bladder rupture). This significantly emphasises the precise control maintained throughout the procedure. Important to emphasise is that the AEs were, in the majority of cases (23 cases, 6.5%, 95,6% of all AEs), unrelated to the robotic system and thus general AEs in the context of colorectal surgery but not for the Senhance\u0026reg; Robotic System. Only a minority (0.3%) were judged, possibly related to the system. These results are showing big improvement as initial findings with the Senhance\u0026reg; Robotic System by Spinelli and colleagues report a postoperative AEs rate of 35.5% [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The Da Vinci System (Intuitive Surgical, Inc., Sunnyvale, CA, USA) has also been investigated multiple times for adverse events. A study by Kim and colleagues reported an adverse event rate of 12% (6 cases) [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Meanwhile, a large-scale study by Huang and colleagues found a postoperative complication rate of 8.8% over five years [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Since we included both intraoperative and postoperative adverse events in our overall complication rate, the results are very favorable for demonstrating safey with the Senhance\u0026reg; Robotic System.\u003c/p\u003e \u003cp\u003eFinally, Robotic-assisted surgery is a minimally invasive approach involving small incisions through which the robotic arms are inserted with surgical instruments and a camera. Typically, this method yields smaller scars, decreased blood loss, diminished pain, and faster recovery times when contrasted with open surgery [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. This can be underlined by our results presenting minimal pain on the postoperative day one and a significant reduction of pain on the day of discharge. The reported pain was adequately managed with standard WHO pain medication and did not differ between our study centers. Regarding blood loss, respective recordings further support the minimal blood loss during robotic surgery. These aspects are, however, not specific to the Senhance\u0026reg; Robotic System but could also be found similarly in laparoscopic surgery [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe study provides comprehensive insights into the outcomes and challenges of robotic-assisted colorectal surgeries with the Senhance\u0026reg; Robotic System across multiple centers. The detailed breakdown of our findings enhances our understanding of the nuances and variations in outcomes across different aspects of colorectal surgery. In conclusion, safety and feasibility are demonstrated with the Senhance\u0026reg; Robotic System, and its application across various surgeries in colorectal surgery is approved.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors contributed to the study's conception and design. Material preparation, data collection and analysis were performed by N.E.S., R.K., V.N., F.W., O.M.H., V.M. . The first draft of the manuscript was written by N.E.S. and V.M. and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eAsensus Surgical US, Inc., Durham, NC, USA, and the TransEnterix European Patient Registry (TRUST) study group supported this study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData is available upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e The authors state that they have no conflicts of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHorgan S, Vanuno D, Benedetti E (2002) Early experience with robotically assisted laparoscopic donor nephrectomy. Surg Laparosc Endosc Percutan Tech 12:64\u0026ndash;70. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/00129689-200202000-00011\u003c/span\u003e\u003cspan address=\"10.1097/00129689-200202000-00011\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChong JU, Lee JY, Lim JH (2023) Early experiences in robotic single-site plus one port platform for complex hepatobiliary and pancreatic surgery. Int J Med Robot:e2602. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/rcs.2602\u003c/span\u003e\u003cspan address=\"10.1002/rcs.2602\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTan K, Peng Y, Li J et al. (2023) Long-term outcomes and cost-effectiveness evaluation of robot-assisted stereotactic hematoma drainage for spontaneous intracerebral hemorrhage. Front Neurol 14:1291634. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fneur.2023.1291634\u003c/span\u003e\u003cspan address=\"10.3389/fneur.2023.1291634\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpinelli A, David G, Gidaro S et al. (2017) First experience in colorectal surgery with a new robotic platform with haptic feedback. Colorectal Dis. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/codi.13882\u003c/span\u003e\u003cspan address=\"10.1111/codi.13882\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLin C-C, Huang S-C, Lin H-H et al. (2021) An early experience with the Senhance surgical robotic system in colorectal surgery: a single-institute study. Int J Med Robot 17:e2206. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/rcs.2206\u003c/span\u003e\u003cspan address=\"10.1002/rcs.2206\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSamalavicius NE, Dulskas A, Janusonis V et al. (2022) Robotic colorectal surgery using the Senhance\u0026reg; robotic system: a single center experience. Tech Coloproctol 26:437\u0026ndash;442. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10151-022-02589-x\u003c/span\u003e\u003cspan address=\"10.1007/s10151-022-02589-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStephan D, S\u0026auml;lzer H, Willeke F (2018) First Experiences with the New Senhance\u0026reg; Telerobotic System in Visceral Surgery. Visc Med 34:31\u0026ndash;36. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1159/000486111\u003c/span\u003e\u003cspan address=\"10.1159/000486111\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSasaki M, Hirano Y, Yonezawa H et al. (2022) Short-term results of robot-assisted colorectal cancer surgery using Senhance Digital Laparoscopy System. Asian J Endosc Surg 15:613\u0026ndash;618. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/ases.13064\u003c/span\u003e\u003cspan address=\"10.1111/ases.13064\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDarwich I, Stephan D, Kl\u0026ouml;ckner-Lang M et al. (2020) A roadmap for robotic-assisted sigmoid resection in diverticular disease using a Senhance\u0026trade; Surgical Robotic System: results and technical aspects. J Robot Surg 14:297\u0026ndash;304. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s11701-019-00980-9\u003c/span\u003e\u003cspan address=\"10.1007/s11701-019-00980-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcKechnie T, Khamar J, Daniel R et al. (2023) The Senhance Surgical System in Colorectal Surgery: A Systematic Review. J Robot Surg 17:325\u0026ndash;334. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s11701-022-01455-0\u003c/span\u003e\u003cspan address=\"10.1007/s11701-022-01455-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSamalavicius NE, Smolskas E, Deduchovas O et al. (2019) Robotic abdominoperineal resection for pT2N0M0 low rectal cancer using the Senhance TransEnterix robotic platform - a video vignette. Colorectal Dis 21:847\u0026ndash;848. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/codi.14638\u003c/span\u003e\u003cspan address=\"10.1111/codi.14638\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSamalavicius NE, Smolskas E, Deduchovas O et al. (2019) Robotic right colectomy using the new Senhance\u0026reg; robotic platform: a three-trocar technique - a video vignette. Colorectal Dis 21:1092\u0026ndash;1093. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/codi.14712\u003c/span\u003e\u003cspan address=\"10.1111/codi.14712\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSamalavicius NE, Smolskas E, Janusonis V et al. (2019) Robotic sigmoid resection for locally advanced cancer using the Senhance Transenterix robotic platform - a video vignette. Colorectal Dis 21:1216. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/codi.14768\u003c/span\u003e\u003cspan address=\"10.1111/codi.14768\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSamalavicius NE, Janusonis V, Smolskas E et al. (2020) Transanal and robotic total mesorectal excision (robotic-assisted TaTME) using the Senhance\u0026reg; robotic system - a video vignette. Colorectal Dis 22:114\u0026ndash;115. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/codi.14837\u003c/span\u003e\u003cspan address=\"10.1111/codi.14837\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSamalavicius NE, Klimasauskiene V, Janusonis V et al. (2020) Robotic total mesorectal excision for mid-rectal cancer using the Senhance\u0026reg; robotic platform - a video vignette. Colorectal Dis 22:592\u0026ndash;593. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/codi.14940\u003c/span\u003e\u003cspan address=\"10.1111/codi.14940\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKondo H, Yamaguchi S, Hirano Y et al. (2020) A first case of ileocecal resection using a Senhance Surgical System in Japan. Surg Case Rep 6:95. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s40792-020-00859-0\u003c/span\u003e\u003cspan address=\"10.1186/s40792-020-00859-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHirano Y, Kondo H, Miyawaki Y et al. (2021) Single-incision plus two-port robotic surgery for sigmoid colon cancer using the Senhance robotic system. Asian J Endosc Surg 14:94\u0026ndash;96. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/ases.12822\u003c/span\u003e\u003cspan address=\"10.1111/ases.12822\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMinagawa Y, Hirano Y, Kataoka A et al. (2021) The first single-incision plus one-port transverse colon resection using Senhance Digital Laparoscopy System: a case report. Surg Case Rep 7:89. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s40792-021-01167-x\u003c/span\u003e\u003cspan address=\"10.1186/s40792-021-01167-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSamalavicius NE, Klimasauskiene V, Janusonis V et al. (2022) Abdominoperineal resection for low rectal neuroendocrine carcinoma after neoadjuvant chemotherapy using the Senhance robotic system with articulating Radia instrument - A Video Vignette. Colorectal Dis 24:798\u0026ndash;799. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/codi.16065\u003c/span\u003e\u003cspan address=\"10.1111/codi.16065\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSamalavicius NE, Klimasauskiene V, Nausediene V et al. (2023) Sigmoid colon resection for sigmoid cancer using a Senhance robotic system and indocyanine green fluorescent angiography-a video correspondence. Colorectal Dis 25:1062\u0026ndash;1063. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/codi.16453\u003c/span\u003e\u003cspan address=\"10.1111/codi.16453\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAabha A. Anekar, Joseph Maxwell Hendrix, Marco Cascella (2023) WHO Analgesic Ladder. In: Anekar AA, Hendrix JM, Cascella M (eds) StatPearls [Internet]. StatPearls Publishing\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSAS Institute Inc (2013) SAS/ACCESS\u0026reg;: Interface to ADABAS. SAS Institute Inc, Cary, NC\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCdc (2022) All About Adult BMI. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html\u003c/span\u003e\u003cspan address=\"https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 25 Feb 2024\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFarah E, Abreu AA, Rail B et al. (2023) Perioperative outcomes of robotic and laparoscopic surgery for colorectal cancer: a propensity score-matched analysis. World J Surg Oncol 21:272. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12957-023-03138-y\u003c/span\u003e\u003cspan address=\"10.1186/s12957-023-03138-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMenke V, Kottmann T, Willeke F et al. (2023) Learning curves and procedural times in Senhance\u0026reg;-robotic assisted fundoplication: results from 237 consecutive patients undergoing robotic fundoplication in a single center as part of the European TRUST Robotic Surgery Registry Study. Surg Endosc 37:8254\u0026ndash;8262. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00464-023-10226-3\u003c/span\u003e\u003cspan address=\"10.1007/s00464-023-10226-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim HS, Oh B-Y, Cheong C et al. (2023) Single-incision robotic colorectal surgery with the da Vinci SP\u0026reg; surgical system: initial results of 50 cases. Tech Coloproctol 27:589\u0026ndash;599. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10151-023-02791-5\u003c/span\u003e\u003cspan address=\"10.1007/s10151-023-02791-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuang Z-X, Zhou Z, Shi H-R et al. (2021) Postoperative complications after robotic resection of colorectal cancer: An analysis based on 5-year experience at a large-scale center. World J Gastrointest Surg 13:1660\u0026ndash;1672. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4240/wjgs.v13.i12.1660\u003c/span\u003e\u003cspan address=\"10.4240/wjgs.v13.i12.1660\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eReddy K, Gharde P, Tayade H et al. (2023) Advancements in Robotic Surgery: A Comprehensive Overview of Current Utilizations and Upcoming Frontiers. Cureus 15:e50415. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.7759/cureus.50415\u003c/span\u003e\u003cspan address=\"10.7759/cureus.50415\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAgha R, Muir G (2003) Does laparoscopic surgery spell the end of the open surgeon? JRSM 96:544\u0026ndash;546. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1258/jrsm.96.11.544\u003c/span\u003e\u003cspan address=\"10.1258/jrsm.96.11.544\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSamalavicius NE, Dulskas. First Clinical experience using augmented intelligence in robotic colorectal cancer surgery with Senhance robotic platform. Ann Coloproctol 2024;1:00\u0026ndash;00 (accepted for publication, in press) \u0026ndash; not yet ready to cite\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Supplementary table 1","content":"\u003cp\u003eSupplementary table 1 is not available with this version.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-robotic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jors","sideBox":"Learn more about [Journal of Robotic Surgery](http://link.springer.com/journal/11701)","snPcode":"11701","submissionUrl":"https://submission.nature.com/new-submission/11701/3","title":"Journal of Robotic Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Robotic Surgery, Colorectal Surgery, Senhance Robotic System, Minimally Invasive, Multi-center Analysis","lastPublishedDoi":"10.21203/rs.3.rs-4615466/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4615466/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIntroduction: Robotic-assisted surgery has revolutionised minimally invasive approaches, particularly in colorectal surgery. While many single-center studies on colorectal surgeries exist in present literature, including experiences with Senhance\u0026reg; Robotic Systems, comprehensive multi-center studies are lacking. This study, conducted through the TransEnterix European Patient Registry (\"TRUST\"), aims to assess the safety and feasibility in this context.\u003c/p\u003e \u003cp\u003eMethods: The present study explored procedural times, complications, robotic malfunction and limitations, adverse events and pain management outcomes for colorectal procedures, including sigmoid resection, right hemicolectomy and rectal surgery collected in two European centers.\u003c/p\u003e \u003cp\u003eResults: Data from 355 colorectal surgeries showed that the median duration of surgery was 147.2 minutes (IQR: 124.3\u0026ndash;183.0), the docking time was reported with a median of 3.4 minutes (IQR: 2.0\u0026ndash;5.4) and the console time was found at a \u003cb\u003emean of\u003c/b\u003e 84.4 minutes (SD: 33.6). Despite minimal blood loss, pain scores, and robotic malfunction, 2,9% of the cases (10 instances) required conversions to either an open or laparoscopic approach. Further, most robotic limitations were attributed to limited motion (18.9%, 67 cases) and collisions (11.5%, 41 cases). Adverse events (24 cases, 6.8%) were effectively managed, with 23 instances judged completely unrelated to the robotic system.\u003c/p\u003e \u003cp\u003eConclusion: This study underscores the positive outcomes and safety profile of Senhance\u0026reg; Robotic Systems in colorectal surgery, contributing valuable insights for future research and clinical practice.\u003c/p\u003e","manuscriptTitle":"Experiences in Robotic Colorectal Surgery: Comprehensive Insights from a Multi-center Analysis Using the Senhance Robotic System","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-12 16:08:53","doi":"10.21203/rs.3.rs-4615466/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Accepted","date":"2024-10-05T20:22:48+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"328680632265657157014846743880041256118","date":"2024-07-15T10:34:56+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-07-15T10:12:43+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-22T14:01:26+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-22T05:32:32+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Robotic Surgery","date":"2024-06-21T06:59:40+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-robotic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jors","sideBox":"Learn more about [Journal of Robotic Surgery](http://link.springer.com/journal/11701)","snPcode":"11701","submissionUrl":"https://submission.nature.com/new-submission/11701/3","title":"Journal of Robotic Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"f466feac-aab7-4e79-a901-825820da9aac","owner":[],"postedDate":"July 12th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-10-28T16:02:43+00:00","versionOfRecord":{"articleIdentity":"rs-4615466","link":"https://doi.org/10.1007/s11701-024-02136-w","journal":{"identity":"journal-of-robotic-surgery","isVorOnly":false,"title":"Journal of Robotic Surgery"},"publishedOn":"2024-10-24 15:57:42","publishedOnDateReadable":"October 24th, 2024"},"versionCreatedAt":"2024-07-12 16:08:53","video":"","vorDoi":"10.1007/s11701-024-02136-w","vorDoiUrl":"https://doi.org/10.1007/s11701-024-02136-w","workflowStages":[]},"version":"v1","identity":"rs-4615466","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4615466","identity":"rs-4615466","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}